You Can’t Always Get What You Want: The Influence of Choice on Nocebo and Placebo Responding

Abstract

Objective

Choice may be an important influence on the effectiveness and side effects of medical treatments.

Purpose

We investigated the impact of having a choice of medication compared to no choice on both nocebo and placebo responding.

Methods

Sixty-one participants were randomly assigned to either choose between or be assigned to one of the two equivalent beta-blocker medications (actually placebos) for pre-examination anxiety.

Results

There was a greater nocebo response in the no choice group and an increased placebo response in the choice group. Participants in the no choice group attributed significantly more side effects to the tablet than the choice group (p = 0.045), particularly at the 24-h follow-up (p = 0.002). The choice group showed a stronger placebo response in heart rate than the non-choice group.

Conclusion

Not being given a choice of medication increased the nocebo effect and reduced the placebo response to the treatment.

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Notes

Acknowledgments

This research was funded by Pharmac New Zealand (the New Zealand Government’s Pharmaceutical Management Agency). The sources of funding for this study played no role in the study’s design, conduct, or reporting.

Compliance with Ethical Standards

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards Authors Bartley, Faasse, Horne, and Petrie declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.